Scully, a medical sociologist, has taken a long hard look at the training of obstetrician/gynecologists and found it sorely wanting: it emphasizes aggressive intervention in childbirth and the reproductive organs, she charges, and creates an ideal climate for exploitation. Scully accompanied OB/GYN residents at their work for two years and describes, disturbingly, how the practice of obstetrics and gynecology and individual physician’s goals (e.g., the need to practice technical skills such as hysterectomies) interact to influence the development of attitudes and skills that are at variance with patients’ health needs; and, since Scully’s research was done in two different teaching hospitals (one private, one public), differences in health care for different groups are clearly illustrated. Scully is not unsympathetic to the residents she studied; but the light she sheds as to their reasons for entering this speciality is not encouraging. Known as “”the happy speciality,”” OB/GYN emphasizes life and avoids death; it’s also an “”ego trip””-especially in infertility treatment-because women are so anxious and grateful.
“Negotiating to do Surgery”
After a potential patient was located, she had to be persuaded to have surgery. As one resident put it: “You have to look for your surgical procedures; you have to go after patients. Because no one is crazy enough to come and say, hey, here I am, I want you to operate on me. You have to sometimes convince the patient that she is really sick, and that she is better off with a surgical procedure.”……”The residents’ tactics, based on high volume, were similar to that of any effective sales person, regardless of the product; that is, the greater the number of contacts, the greater the probability of making a sale. This type of high-turnover sale was especially suited to the high-volume, quick turnover conditions in the clinics and emergency room. Like any sophisticated salesperson, a resident could judge within minutes whether a woman was going to buy a hysterectomy. When it appeared that she wasn’t, he used another tactic. Residents believed that women would eventually accept surgery if they were given some time to think it over. Thus, after a resident had completed his pitch and the woman was still reluctant, he would tell her that he would call her in a week and discuss the surgery further. The woman was dismissed and the next prospective case was brought into the examining room. The entire interaction, including physical examination, usually took three or four minutes”….. “Once the woman agreed to surgery, she lost whatever power she previously had had – the power of refusal. The situation changed from one of negotiation to complete control by the resident. The patient was expected to trust the knowledge and wisdom of her doctor. She was not consulted on the form her surgery would take nor was it expected that she was capable of understanding medical-surgical mysteries. The resident, influenced by his own need for practice, decided what operation he would do. Women were not aware that there was a choice.”…..”Surgical teaching programs are having increasing difficulty finding subjects to learn on because they greatly depend on the availability of ward or indigent patients and with increased third-party payments, the number of such patients is shrinking. As a consequence, residents in many city hospitals have done more “selling.”…….” To improve my surgical technique and to get a chance to do some of the surgeries that we don’t get a chance to do otherwise, I went for radical surgery where your dissect out everything; you look for everything”…. “I do enjoy it, and think any doctor is lucky to do radical surgery”…..”It is by mistakes that you grow and mature as a physician. You learn not to do it again; I think that is important. Because if I wasn’t ever going to make any mistakes, there wouldn’t be any reason for me to spend four years being a resident”…..”I don’t know if you can call it a mistake or something that you aren’t experienced with and do something wrong. You can’t call it a mistake. It’s inexperience. If you aren’t taught something, you can’t do it.”….